Chapter 16: Drug Therapy to Decrease Pain, Fever, and Inflammation PrepU

A patient reports pain in the right foot from gout. He states he is allergic to all nonsteroidal anti-inflammatory medications. What does the nurse anticipate as the drug therapy to control the acute episode for this patient? a. Colchicine b. Aspirin c. Acetaminophen (Tylenol) d. Methotrexate

a. Colchicine NSAIDS are the initial drugs of choice for the management of acute gout. When NSAIDS are contraindicated or cannot control the acute episode, colchicine or glucocorticoid steroids may be used. The choice between colchicine and steroids depends on the preference of the health care provider.

A nurse is caring for a client with low back pain, who has self-administered large doses of ibuprofen for several consecutive days. The nurse should caution the client that overuse of ibuprofen may lead to which? a. GI irritation b. fever c. headache d. dry mouth

a. GI irritation Adverse effects of ibuprofen and other nonsteroidal anti-inflammatory drugs include GI irritation, ulceration, and bleeding. Fever, headache and dry mouth are not associated with the use of ibuprofen.

A 60-year-old patient with rheumatoid arthritis visits the health care facility for a regular checkup. The patient informs the nurse that the patient has been using an over-the-counter NSAID for the last few days. Why should the nurse caution the patient against the use of NSAIDs on a long-term basis? a. Increased risk of GI bleeding b. Increased risk of CNS disorders c. Increased risk of hearing impairment d. Increased risk of blindness

a. Increased risk of GI bleeding The nurse should caution the older adult against the use of NSAIDs on a long-term basis because they increase the risk of GI bleeding. CNS disorders, hearing impairment, and blindness are not the effects of using NSAIDs on a long-term basis in older patients.

The nurse would question the health care provider who prescribed nonsteroidal anti-inflammatory drugs (NSAIDs) for which client? a. The client diagnosed with peptic ulcers b. The client diagnosed with diabetes c. The client diagnosed with psoriasis d. The postpartum woman who had a vaginal birth

a. The client diagnosed with peptic ulcers The client diagnosed with peptic ulcer disease is at risk for further GI irritation and bleeding if given NSAIDs, so the nurse would question the health care provider who ordered this drug. Clients with diabetes and psoriasis may take NSAIDs safely and the nurse would not question the order. NSAIDs are often ordered for pain control for clients following vaginal birth and this order need not to be questioned.

Aspirin has been prescribed for a 69-year-old client with a diagnosis of arthritis. The nurse monitors the client for which assessment finding that would indicate the presence of toxicity from this medication? (Select all that apply.) a. Tinnitus b. Impaired hearing c. Constipation d. Photophobia

a. Tinnitus b. Impaired hearing Symptoms of salicylism include tinnitus, impaired hearing, dizziness, nausea, vomiting, flushing, tachycardia, and mental confusion. Constipation and photophobia are not associated with salicylism.

Aspirin has been prescribed for a 69-year-old client with a diagnosis of arthritis. The nurse monitors the client for which assessment finding that would indicate the presence of toxicity from this medication? (Select all that apply.) a. Tinnitus b. Impaired hearing c. Tachycardia d. Diarrhea e. Photophobia

a. Tinnitus b. Impaired hearing c. Tachycardia Symptoms of salicylism include tinnitus, impaired hearing, dizziness, nausea, vomiting, flushing, tachycardia, and mental confusion. Diarrhea and photophobia are not associated with salicylism.

The nurse is conducting a medication reconciliation of a new resident of a long-term care facility. The nurse notes that the resident takes allopurinol on a daily basis for the treatment of gout. What is the primary purpose of this drug? a. To balance urate concentration and prevent gout attacks b. To promote the remodeling of damaged synovium c. To potentiate the metabolism of dietary purines d. To achieve pain relief in joints affected by gout

a. To balance urate concentration and prevent gout attacks Uricosuric drugs such as allopurinol help to balance urate levels and thus prevent gout attacks. They do not influence the remodeling of synovial membrane, provide analgesia, or affect the metabolism of purines.

A 60-year-old man has told the nurse that he has been treating his joint pain with regular doses of ibuprofen. In order to ascertain the man's risks of experiencing adverse effects, the nurse should assess the patient's a. alcohol intake. b. calcium intake. c. body mass index. d. skin integrity.

a. alcohol intake. Heavy alcohol use may predispose a patient to hepatic dysfunction. Calcium intake, BMI, and skin integrity are not central assessments with regard to potentially adverse effects.

A nurse is reviewing the medical record of a client who is prescribed nonsteroidal anti-inflammatory drug (NSAID) therapy. The nurse determines that the drug would be contraindicated for the client if a hypersensitivity to which drug was found? a. aspirin b. acetaminophen c. hydrochlorothiazide d. lisinopril

a. aspirin A hypersensitivity to aspirin is a contraindication for all NSAIDs. The alternative to aspirin for fever and pain when aspirin is contraindicated is usually acetaminophen. Hydrochlorothiazide and lisinopril are antihypertensives.

A nurse is caring for a 61-year-old man who has had a severe attack of gout while in the hospital for food poisoning. What is the reason the nurse administers colchicine intravenously to this specific client? a. avoid aggravating the gastrointestinal tract. b. ensure quick distribution of the drug. c. prevent the risk of infection or bleeding. d. minimize the risk of depressed bone marrow function.

a. avoid aggravating the gastrointestinal tract. The patient is given colchicine intravenously to avoid aggravating his gastrointestinal tract. Giving the drug intravenously may ensure quick distribution of the drug, but considering the patient's food poisoning, the main objective would be to avoid aggravating the gastrointestinal tract and symptoms that the patient already has. Giving the drug intravenously does not prevent infection, bleeding, or depressed bone marrow function.

A nurse is reviewing a journal article about a nonsteroidal anti-inflammatory drug (NSAID) that is associated with an increased risk of cardiovascular thrombosis, myocardial infarction, and stroke. The nurse is most likely reading about which drug? a. celecoxib b. sulindac c. oxaprozin d. ketorolac

a. celecoxib Celecoxib is associated with an increased risk of cardiovascular thrombosis, myocardial infarction, and stroke; however, all NSAIDs may carry a similar risk. Sulindac carries the risk of headache, dizziness, and GI upset. Oxaprozin carries the risk of headache, dizziness, insomnia, and ringing in the ears. Ketorolac carries the risk of GI upset, renal effects, and congestive heart failure.

Which nonsteroidal anti-inflammatory drug (NSAID) appears to work by specifically inhibiting cyclooxygenase-2 (COX-2) without inhibiting cyclooxygenase-1 (COX-1)? a. celecoxib b. ibuprofen c. naproxen d. meloxicam

a. celecoxib Celecoxib is the NSAID that appears to work by specifically inhibiting cyclooxygenase-2 without inhibiting cyclooxygenase-1. Naproxen, meloxicam, and ibuprofen inhibit both COX-1 and COX-2.

A healthcare provider has recommended the use of acetaminophen to treat the client's pain. What should the nurse teach the client about safe and effective use of acetaminophen? a. Avoid taking more than the recommended dose b. Avoid drinking grapefruit juice with acetaminophen c. Take the medication with food to prevent GI upset d. Avoid excessive doses because there is no antidote

a. Avoid taking more than the recommended dose Clients should avoid taking more than the recommended dose of acetaminophen to avoid hepatic damage. Acetylcysteine is an antidote for overdose and there is no need to avoid grapefruit juice. GI upset is rare, so there is no particular need to take it with food.

A client's history reveals an allergy to sulfonamides. The nurse understands that which drug would be contraindicated? a. Celecoxib b. Ibuprofen c. Naproxen d. Diclofenac

a. Celecoxib Celecoxib is contraindicated for use in clients who are allergic to sulfonamides. Ibuprofen, naproxen, and diclofenac are not contraindicated in the client with a sulfonamide allergy.

The nurse is educating the patient who will be taking colchicine at home. What important information should the nurse be sure to include in the education? a. Avoid the use of alcohol because it will lead to colchicine toxicity. b. Avoid the use of alcohol because it will decrease the antigout effects of colchicine. c. If joint pain occurs, take ibuprofen while using the colchicine for pain relief. d. Be sure to take colchicine with a glass of milk to decrease the gastrointestinal side effects.

b. Avoid the use of alcohol because it will decrease the antigout effects of colchicine. Ethanol ingestion increases the risk of adverse GI effects and can increase serum urate concentration, thus decreasing the antigout effects of colchicine.

A group of students is reviewing information about cyclooxygenase receptors. The students demonstrate understanding of the information when they identify what as an effect of COX-2 receptors? a. Maintenance of renal function b. Blockage of platelet clumping c. Provision of gastric mucosal integrity d. Promotion of vascular hemostasis

b. Blockage of platelet clumping COX-2 receptors block platelet clumping. COX-1 receptors maintain renal function, provide for gastric mucosal integrity, and promote vascular hemostasis.

Which of the following is a serious risk involved in the use of NSAIDs? a. Increased granulocyte count b. Cardiovascular thrombosis c. Increased WBC count d. Sickle cell anemia

b. Cardiovascular thrombosis A serious risk involved in the use of NSAIDs is cardiovascular thrombosis. Increased granulocyte count, increased WBC count, or sickle cell anemia is not caused by NSAIDs. Sickle cell anemia results from an inherited abnormality of hemoglobin. NSAIDs may cause decreased granulocyte count, decreased WBC count, or aplastic anemia.

A nurse has admitted a 10-year-old to the short-stay unit. The child reports chronic headaches, and his mother states that she gives the child acetaminophen at least twice a day. What will the nurse evaluate? a. Renal function b. Hepatic function c. Respiratory function d. Cardiac function

b. Hepatic function The nurse should evaluate the patient's hepatic function. Severe hepatotoxicity can occur from over use of acetaminophen. Significant interferences do not occur in the kidney, heart, or lung with acetaminophen.

Which agent would be least appropriate to administer to a client with joint inflammation and pain? a. Ibuprofen b. Naproxen c. Acetaminophen d. Diclofenac

c. Acetaminophen Acetaminophen has analgesic and antipyretic properties but does not exert an anti-inflammatory effect. Therefore, it would not be indicated for joint inflammation. Ibuprofen, naproxen, and diclofenac have anti-inflammatory properties and would be appropriate for use.

Which of the following interventions should a nurse perform for a patient who is experiencing gastric upset while taking magnesium salicylate? a. Administer drug with orange juice. b. Include fiber-rich food in the patient's diet. c. Administer antacids to minimize GI distress. d. Ensure drug is given at least three hours before meals.

c. Administer antacids to minimize GI distress. The nurse may administer antacids to minimize GI distress. Instead of orange juice, the nurse may administer the drug with milk to alleviate a gastric upset. The nurse can also administer the drug with food to relieve the gastric upset instead of giving the drug three hours before a meal. Including fiber-rich food in the patient's diet will not significantly relieve gastric upset.

Acetaminophen is frequently used as a substitute for aspirin. What effects of aspirin are absent in acetaminophen? a. Antiplatelet and antipyretic effects b. Analgesic and antipyretic effects c. Anti-inflammatory and antiplatelet effects d. Anti-inflammatory and analgesic effects

c. Anti-inflammatory and antiplatelet effects Acetaminophen is commonly used as an aspirin substitute, because it lacks aspirin's antiplatelet effects. It also lacks aspirin's anti-inflammatory effect. Acetaminophen has antipyretic and analgesic effects equal to those of aspirin.

A patient comes to the clinic reporting throbbing pain that started at night and intolerance to covers on the foot. The nurse observes swelling at the site of the first metatarsophalangeal (MTP) joint. For what disorder does the nurse anticipate the patient will be treated? a. Osteoarthritis b. Chronic gouty arthritis c. Rheumatoid arthritis d. Acute gouty arthritis

d. Acute gouty arthritis The onset of acute gouty arthritis is rapid. The pain frequently starts during the night and is often described as throbbing, crushing, or excruciating. The affected joints show signs of warmth, redness, and tenderness. In more than half of the initial attacks, the onset is in the first MTP, and overall 90% of patients have the MTP affected at some point.

A home care nurse is seeing a 66-year-old female who has just been released from the hospital after being treated for pneumonia. The nurse knows that it is important to assess the client's knowledge of which area? a. Medication regimen for herbal supplements b. Exercise routine c. Nutrition and health d. Adverse effects of nonsteroidal anti-inflammatory drugs

d. Adverse effects of nonsteroidal anti-inflammatory drugs In addition, adverse drug effects should be reviewed with clients, and clients should be assessed for characteristics (e.g., older age group, renal impairment, overuse of the drugs) that increase the risks of adverse effects.

A patient with arthritis is on nonsteroidal anti-inflammatory drug (NSAID) therapy. What should be evaluated by the nurse to determine the effectiveness of NSAID therapy? a. Blood sugar b. Respiratory rate c. Body temperature d. Better mobility

d. Better mobility The nurse should report better mobility in the patient after NSAID drug therapy for arthritis. The patient's blood sugar, respiratory rate, and body temperature are not affected and, hence, are not evaluated by the nurse after treatment.

The 56-year-old client is diagnosed with osteoarthritis and reports joint pain and stiffness. Which medication would be identified as appropriate for the client to take? a. Eletriptan b. Ergotamine c. Sumatriptan d. Celecoxib

d. Celecoxib Celecoxib is a COX-2 inhibitor used to treat pain related to osteoarthritis. Eletriptan, sumatriptan, and ergotamine are medications used to treat migraines.

What best describes the action of nonsteroidal anti-inflammatory drugs (NSAIDs)? a. Blocks hypothalamus activity b. Act directly on thermoregulatory cells c. Inhibit phagocytosis d. Inhibit prostaglandin synthesis

d. Inhibit prostaglandin synthesis Nonsteroidal anti-inflammatory drugs (NSAIDs) inhibit prostaglandin synthesis. Salicylates block prostaglandin activity. Acetaminophen acts directly on thermoregulatory cells in the hypothalamus. Gold salts inhibit phagocytosis.

In which children or teenagers is the use of salicylates, particularly aspirin, contraindicated because their use appears to be associated with Reye syndrome? a. Patients with hepatic dysfunction b. Patients with high BP c. Patients with diabetes d. Patients with chickenpox

d. Patients with chickenpox Children or teenagers with influenza or chickenpox should not take salicylates, particularly aspirin, because their use appears to be associated with Reye syndrome, a life-threatening condition characterized by vomiting and lethargy progressing to coma. Even though salicylates need to be administered with caution in patients with hepatic dysfunction, high blood pressure, and diabetes, their use does not lead to Reye syndrome.

A group of nursing students are reviewing the pain-relieving action of NSAIDs. The students demonstrate understanding of the information when they identify which actions as being blocked to achieve pain relief? a. cyclooxygenase-2 b. cyclooxygenase-1 c. cyclooxygenase-3 d. cyclooxygenase-4

a. cyclooxygenase-2 Blocking COX-2 is responsible for the pain-relieving effects of NSAIDs. COX-1 is an enzyme that helps to maintain the stomach lining; inhibition of COX-1 would cause unwanted gastrointestinal (GI) reactions such as stomach irritation and ulcers. The antipyretic action of aspirin may be mediated by inhibition of COX-3 in hypothalamic endothelial cells. No data are obtained on the discovery of COX-4.

A client is admitted to the emergency department with suspect salicylism. The client's plasma salicylate level is 300 mcg/mL. Which sign/symptom would the nurse expect to assess? Select all that apply. a. headache b. thirst c. flushing d. asterixis e. tetany

a. headache b. thirst c. flushing A client with a plasma salicylate level of 300 mcg/mL would exhibit the following: tinnitus, difficulty hearing, dizziness, nausea, vomiting, diarrhea, mental confusion, central nervous system depression, headache, sweating, and hyperventilation and flushing. Asterixis is noted with plasma salicylate levels above 400 mcg/mL. Tetany would be noted with plasma salicylate levels above 400 mcg/mL.

A patient with gout has been prescribed colchicine, which he is to take orally each day. When providing relevant health education for this patient, the nurse should emphasize the need to avoid a. sardines. b. high-salt foods. c. food additives. d. simple sugars.

a. sardines. The patient should be encouraged to follow a low-purine diet by avoiding beer, alcohol, organ and game meats, sardines, anchovies, scallops, asparagus, spinach, and peas. Salt, food additives, and simple sugars should always be eaten in moderation, but none is contraindicated with colchicine therapy.

A nurse is preparing to teach a client about the adverse effects of prescribed nonsteroidal anti-inflammatory drug (NSAID) therapy. The nurse plans to focus on the most common adverse reactions caused by this group of drugs. Which effects would the nurse include as being involved? a. stomach b. lungs c. liver d. peripheral nerves

a. stomach The most common adverse reactions caused by the NSAIDs involve the GI tract, including the stomach, leading to GI bleed and/or possible ulceration. The lungs are not specifically affected by NSAIDs; however, pain associated with respiratory insults such as pneumonia can be relieved. Peripheral nerve pain can also be treated with NSAIDs. There is no injury noted to the liver while taking NSAIDs.

The nurse knows, that as a COX-1 inhibitor, indomethacin inhibits prostaglandins associated with which tissues? a. Kidneys and female reproductive system b. All tissues and cell types c. Heart, brain, and kidneys d. Liver, kidneys, and GI tract

b. All tissues and cell types COX-1 is present in all tissues and cell types, especially platelets, endothelial cells, the GI tract, and the kidneys. Prostaglandins produced by COX-1 are important in numerous homeostatic functions and are associated with protective effects on the stomach and kidneys.

The nurse is caring for the patient with chronic gout. The patient has elevated uric acid levels. What medication would the nurse be administering for this patient? a. Colchicine b. Allopurinol c. Nonsteroidal anti-inflammatory medications such as Aleve d. Prednisone

b. Allopurinol Chronic gout, defined as repeated episodes of gout, is treated with uricosuric drugs, which decrease the hyperuricemia associated with gout. The prototype uricosuric drug is allopurinol.

What effects are exerted by aspirin? (Select all that apply.) a. Analgesic b. Antipyretic c. Anti-inflammatory d. Anti-infective e. Antiviral

a. Analgesic b. Antipyretic c. Anti-inflammatory Aspirin is a salicylate. Salicylates are useful in pain management because of their analgesic, antipyretic, and anti-inflammatory effects.

What should a nurse recognize as a property of ibuprofen/Motrin? (Select all that apply.) a. Anti-inflammatory b. Analgesic c. Antipruritic d. Antipyretic e. Antibacterial

a. Anti-inflammatory b. Analgesic d. Antipyretic Like the salicylates, the NSAIDS have anti-inflammatory, antipyretic, and analgesic effects.

Which instruction would be most important to include when teaching parents about over-the-counter (OTC) anti-inflammatory agents? a. "Be sure to read the label for the ingredients and dosage." b. "Aspirin is best for treating your child's flulike symptoms." c. "Make sure to give the drug on an empty stomach or before meals." d. "Refrain from using acetaminophen for the child's symptoms."

a. "Be sure to read the label for the ingredients and dosage." Care must be taken to make sure that the child receives the correct dose of any anti-inflammatory agent. This can be a problem because many of these drugs are available in OTC pain, cold, flu, and combination products. Parents need to be taught to read the label to find out the ingredients and the dosage they are giving the child. Aspirin for flulike symptoms in children is to be avoided due to the increased risk for Reye's syndrome. Children are more susceptible to the GI and central nervous system effects of these drugs, so the drugs should be given with food or meals. Acetaminophen is the most used anti-inflammatory drug for children. However, parents need to be cautioned to avoid overdosage, which can lead to severe hepatotoxicity.

A client diagnosed with gout reports having no symptoms of the disease and asks why allopurinol was prescribed. How will the nurse best respond? a. "It is used to prevent or treat hyperuricemia, which occurs with gout." b. "It is used to cure hyperuricemia, which occurs with gout." c. "It is used in combination with another drug to prevent reoccurrences." d. "It is not a first-line drug but can be used for gout."

a. "It is used to prevent or treat hyperuricemia, which occurs with gout." Allopurinol is the drug of choice for gout due to "overproduction" of uric acid. It is used to prevent or treat (but not cure) hyperuricemia, by preventing formation of uric acid and promoting resorption of urate deposits.

A female client with acute joint inflammation asks the nurse why she shouldn't use acetaminophen for her condition. What would be the nurse's best response to this client? a. "The drug has no effect on inflammation." b. "The drug has quite a few adverse effects." c. "This drug is reserved for long-term therapy." d. "The drug can increase your risk for bleeding."

a. "The drug has no effect on inflammation." The drug has antipyretic and analgesic properties, but no anti-inflammatory properties. Acetaminophen does have adverse effects including hepatotoxicity secondary to chronic use or overdose. Long-term therapy or overdosage can lead to hepatotoxicity. The drug does not increase a person's risk for bleeding.

A client is alarmed to be prescribed celecoxib (Celebrex), stating, "I heard on TV that Celebrex causes heart attacks." How should the nurse best respond? a. "This drug hasn't been definitively proven to be unsafe, so it's still available." b. "A final decision from the FDA on whether Celebrex is safe will be released in 2018." c. "As long as you take your heart medications, you'll be fine." d. "That was a scare that was entirely created by the media."

a. "This drug hasn't been definitively proven to be unsafe, so it's still available." Celecoxib remains on the market despite a 2 to 3 times increase in CV events because further research called into question these findings and the drug continues to be monitored. There is no promise of a decision in 2018. The media played a role in the public response, but did not wholly create the controversy.

A male client is taking aspirin 81 mg by mouth each day for prevention of recurrent myocardial infarction. He makes a dentist appointment for a tooth extraction. He calls the health care provider's office and asks the nurse if he is at risk for bleeding. Which response is correct? a. "Yes, low doses of aspirin may increase your risk of bleeding; I will call you with your new prescriber's orders." b. "No, the dose of aspirin is too low to increase your risk of bleeding." c. "Yes, you need to stop the aspirin immediately." d. "Your dentist must extract the tooth in a hospital setting to reduce the risk of hemorrhage."

a. "Yes, low doses of aspirin may increase your risk of bleeding; I will call you with your new prescriber's orders." If a client has a history of taking aspirin, including the low doses prescribed for antithrombotic effects, there is a risk of bleeding from common therapeutic procedures (e.g., intramuscular injections, venipuncture, insertion of urinary catheters or GI tubes) or diagnostic procedures (e.g., drawing blood, angiography).

Patients are often given a daily dose of aspirin for prophylaxis of myocardial infarction (MI), transient ischemic attacks (TIA), and cerebrovascular accident (CVA). What is the recommended daily dose for this purpose? a. 81-325 mg b. 180-240 mg c. 360-460 mg d. 600-650 mg

a. 81-325 mg The recommended daily dose for prophylaxis of MI, TIA, and CVA is 81-325 mg. The indication stems from aspirin's ability to decrease formation of blood clots.

Which client is at highest risk for developing hepatotoxicity related to the use of acetaminophen? a. A male 30 years of age who drinks four beers per day b. A male 40 years of age with arthritis c. A female 50 years of age with hypoprothrombinemia d. A female 62 years of age with a vitamin K deficiency

a. A male 30 years of age who drinks four beers per day Clients who consume more than three drinks per day habitually are at increased risk for developing hepatotoxicity. Aspirin should be used cautiously in clients with a vitamin K deficiency and hypoprothrombinemia.

A male client is seeking an over-the-counter medication to ease both the pain and inflammation associated with his osteoarthritis of his knee. The nurse knows that which drug will only reduce pain? a. Acetaminophen b. Aspirin c. Naproxen sodium d. Ibuprofen

a. Acetaminophen Acetaminophen is not an anti-inflammatory medication. It is an analgesic and an antipyretic. Aspirin, naproxen sodium, and ibuprofen decrease pain and inflammation.

An adult client has been admitted to the emergency department after deliberately overdosing on approximately 50 grams of acetaminophen. The nurse should prepare for what intervention? a. Administration of acetylcysteine as prescribed b. Watchful waiting c. Administration of naloxone as prescribed d. Intravenous administration of Lactated Ringer's

a. Administration of acetylcysteine as prescribed Acetylcysteine is the antidote to acetaminophen overdose. Naloxone treats opioid overdoses. Given the high dose of acetaminophen, watchful waiting would be inadequate. Lactated Ringer's would not be therapeutically beneficial.

What drug is useful in the management of gout because of its ability to inhibit the formation of uric acid crystals? a. Allopurinol b. Probenecid c. Colchicine d. Salicylic acid

a. Allopurinol Allopurinol inhibits xanthine oxidase, an enzyme responsible for the formation of uric acid in the body. This inhibition lowers the uric acid concentration, which results in formation of fewer uric acid crystals.

A client prescribed allopurinol denies any current symptoms of gout. What response should the nurse provide when the client asks why the medication has been prescribed? a. "Allopurinol promotes formation of uric acid. It is used in combination with another drug to prevent reoccurrences of the symptoms of gout." b. "Allopurinol is used to prevent or treat hyperuricemia, which commonly occurs with gout." c. "Allopurinol is used to cure hyperuricemia, which commonly occurs with gout." d. "Allopurinol is not a first-line drug but can be used to cure gout."

b. "Allopurinol is used to prevent or treat hyperuricemia, which commonly occurs with gout." Allopurinol is used to prevent or treat (but not cure) hyperuricemia, which occurs with gout and with antineoplastic drug therapy. Allopurinol prevents formation of uric acid. The drug promotes resorption of urate deposits and prevents their further development. Allopurinol is among the first-line drugs used in the treatment of gout but does not cure the condition.

A 16-year-old female client asks the nurse if she can take two Tylenol every 2 hours during exams because it helps relieve her tension headaches. What is the nurse's most appropriate response? a. "Why do you feel so tense regarding exams?" b. "Do not exceed recommended doses of acetaminophen due to the risk of life-threatening liver damage." c. "Consult your health care provider." d. "Acetaminophen is a benign drug and will relieve your pain."

b. "Do not exceed recommended doses of acetaminophen due to the risk of life-threatening liver damage." Do not exceed recommended doses of acetaminophen due to risk of life-threatening liver damage. People with liver disorders such as hepatitis or those who ingest alcoholic beverages frequently should use it with extreme caution.

The client states that he knows many people who take acetaminophen, and asks the nurse what it is used for. What is the best response by the nurse? a. "It is used to treat severe arthritis." b. "It is an aspirin substitute for pain and fever." c. "It is used to treat chronic pain." d. "It is an anti-inflammatory medication."

b. "It is an aspirin substitute for pain and fever." Acetaminophen is used to treat mild to moderate pain, and fever. It has no anti-inflammatory effect and will not address pain related to severe arthritis.

Aspirin increases the risk of bleeding and should generally be avoided for how many weeks before and after surgery? a. 3 to 4 weeks b. 1 to 2 weeks c. 6 to 8 weeks d. 2 to 3 weeks

b. 1 to 2 weeks Aspirin should generally be avoided for 1 to 2 weeks before and after surgery, because it increases the risk of bleeding. Most other NSAIDs should be discontinued approximately 3 days before surgery; nabumetone and piroxicam have long half-lives and must be discontinued approximately 1 week before surgery. NSAIDs, administered intraoperatively, have been shown to reduce postoperative pain and use of opioids after abdominal surgery.

Which of the following patients would the nurse determine has the highest risk of cumulative toxicity if prescribed colchicine? a. A pregnant patient b. A patient with hepatic disease c. A patient undergoing radiation therapy d. A patient with myelosuppression

b. A patient with hepatic disease Colchicine is eliminated primarily through the biliary tract. Therefore, patients with hepatic disease face the highest risk for cumulative toxicity, if they were to be administered colchicine. Patients with myelosuppression are at risk for infections or bleeding. Patients undergoing radiation therapy do not face the risk of drug toxicity. Pregnant women do not face an increased risk of cumulative toxicity; however, colchicine is in pregnancy category D and should never be given in pregnancy.

An older adult male patient has begun treatment for gout after an extensive diagnostic workup. The nurse who is contributing to the patient's care should understand that gout is a result of what pathophysiological process? a. Excess purine intake initiates an autoimmune process that impairs joint function. b. Hyperuricemia causes crystals to precipitate in the synovial fluid. c. Lack of joint mobility causes impaired uric acid metabolism. d. Mechanical damage to the joints results in increased release of uric acid.

b. Hyperuricemia causes crystals to precipitate in the synovial fluid. Gout occurs when hyperuricemia forms monosodium urate crystals. These precipitate into the synovial fluid and cause an inflammatory response. Gout does not primarily result from mechanical damage, lack of mobility, or autoimmune processes.

A nurse is caring for a client in the early stage of rheumatoid arthritis. The nurse would expect which medication classification to be used in the treatment of this client? a. Antimalarial agents b. Nonsteroidal anti-inflammatory drugs (NSAIDs) c. Xanthine oxidase inhibitors d. Uricosuric agents

b. Nonsteroidal anti-inflammatory drugs (NSAIDs) The NSAIDs are indicated for relief of the signs and symptoms of rheumatoid arthritis and osteoarthritis, for relief of mild to moderate pain, for treatment of primary dysmenorrhea, and for fever reduction. Antimalarial agents are used in the treatment of systemic lupus erythematosus. Xanthine oxidase inhibitors and uricosuric agents are used in the treatment of gout.

A nurse is caring for a client with severe rheumatoid arthritis. The health care provider has ordered an anti-inflammatory medication for the client. What should the nurse question if it is ordered? a. Oral antidiabetic agent b. Oral anticoagulant c. Antihypertensive agent d. Antibiotic

b. Oral anticoagulant There is an increased risk of bleeding when taking an oral anticoagulant with an anti-inflammatory. Antidiabetic agents, antihypertensives, and most antibiotics can be given safely with anti-inflammatory agents.

A 15-year-old client is brought to the emergency department by his friends. He reports visual changes, drowsiness, and tinnitus. He is confused and hyperventilating. These symptoms may be attributable to which condition? a. Acute acetaminophen poisoning b. Salicylate intoxication c. Ibuprofen overdose d. Caffeine abuse

b. Salicylate intoxication Symptoms of salicylate intoxication include nausea, vomiting, fever, fluid and electrolyte deficiencies, tinnitus, decreased hearing, visual changes, drowsiness, confusion, and hyperventilation. The scenario described does not suggest acetaminophen poisoning, ibuprofen overdose, or caffeine abuse.

A nurse is teaching a patient about his newly prescribed drug, colchicine, for gout. The nurse will instruct the patient to avoid which of the following foods? a. Green beans b. Shrimp c. Eggs d. Milk

b. Shrimp High consumption of meat products and seafood increases the risk of hyperuricemia, which is the root cause of gout. Purine-rich vegetables do not increase the risk of hyperuricemia, and a high dairy intake is actually protective.

The client has been prescribed one aspirin a day. The nurse understands that is prescribed for which of the following? a. To treat osteoarthritis b. To inhibit platelet aggregation c. To decrease pain d. To decrease temperature

b. To inhibit platelet aggregation Daily low-dose aspirin is prescribed to inhibit platelet aggregation within the heart and brain. Aspirin for osteoarthritis and pain is usually prescribed at a higher dosage. If the client is having elevated temperatures daily, the cause would need to be investigated.

Prior to administering NSAIDs, the nurse asks the client about an allergy to: a. acetaminophen. b. aspirin. c. antibiotics. d. analgesics.

b. aspirin. Aspirin allergy is a contraindication for all NSAIDs. Antibiotics and acetaminophen allergies do not affect NSAID use. Analgesics include a wide variety of medications.

A 70-year-old woman on long-term ibuprofen therapy for osteoarthritis has returned to the clinic for her regular 6-month visit. The client states that in the last couple of months, she has been having increasing periods of abdominal pain. The nurse suspects that this pain may be related to which? a. anemia. b. peptic ulcer disease or gastritis. c. interstitial nephritis. d. constipation.

b. peptic ulcer disease or gastritis. During long-term ibuprofen therapy, especially in clients older than 60 years, the nurse needs to closely monitor for peptic ulcer disease or gastritis that can lead to gastrointestinal bleeding or even bowel perforation. These events can occur at any time, with or without warning. Ibuprofen may also cause excessive or abnormal bleeding, especially in clients with anemia, but it is not known to cause anemia. Interstitial nephritis is one of the less common renal toxicities associated with ibuprofen as is constipation.

When monitoring the efficacy of allopurinol therapy, the nurse should prioritize the results of what diagnostic test? a. liver enzymes b. serum uric acid levels c. absolute neutrophil count d. C-reactive protein level (CPR)

b. serum uric acid levels It is vital to assess serum uric acid levels in the client being treated with allopurinol. Efficacy is not determined by analysis of CRP levels, liver enzymes, or neutrophil levels since none monitor uric acid levels.

An 80-year-old male client presents to the health care provider's office with reports of fatigue and a change in the color of stools. He self-administers ibuprofen 400 mg each night for general discomfort. The provider orders a stool test for guaiac (occult blood), which yields positive results. The provider discontinues the ibuprofen. The nurse is responsible for a client education plan. The client should be educated regarding what as a risk with chronic use of NSAIDs? a. GI discomfort b. GI distress c. GI bleed d. GI upset

c. GI bleed Older clients on long-term NSAID therapy should be evaluated for GI blood loss, renal dysfunction, edema, hypertension, and drug-drug or drug-disease interactions (level A). Use of gastroprotective agents is recommended for people at risk of upper GI bleeding events (level B). COX-2 inhibitors may be preferred in older adults, because they are less likely to cause gastric ulceration and bleeding; however, this benefit must be weighed against the increased risk of cardiovascular events.

A 78-year-old male client calls the clinic and reports severe pain and swelling in his right great toe. The client states that the pain is worse at night and has been present for at least 2 weeks. The nurse understands that this client has what type of inflammatory disorder? a. Osteoarthritis of the toe b. Probable fracture of the toe c. Gout d. Spondylarthritis

c. Gout Severe pain and swelling in the great toe that is worse at night and lasts longer than 10 days is most likely gout.

A salicylate is contraindicated in clients who have had surgery within the past week for which reason? a. Increased risk for allergic reaction b. Increased risk for toxicity c. Increased risk for bleeding d. Increased risk for fluid imbalance

c. Increased risk for bleeding Salicylates are contraindicated for clients who have had surgery within the past week because of the increased risk for bleeding. Their use in clients with an allergy to salicylates or tartrazine would increase the risk for an allergic reaction. Their use in clients with impaired renal function may increase the risk for toxicity because the drug is excreted in the urine. There is no associated risk for fluid imbalance and salicylate therapy.

A client presents at the emergency department reporting dizziness, mental confusion, and difficulty hearing. What should the nurse suspect is the client's issue? a. Anakinra toxicity b. Ibuprofen toxicity c. Salicylism d. Acetaminophen toxicity

c. Salicylism Salicylism can occur with high levels of aspirin. Dizziness, ringing in the ears, difficulty hearing, nausea, vomiting, diarrhea, mental confusion, and lassitude can occur.

A 65-year-old man who just had a heart attack is placed on aspirin, 81 mg daily. The nurse is explaining the purpose of this medication to the client and his wife. What would be the nurses best explanation? a. The aspirin is being prescribed because it reduces the prostaglandins in your body. b. The aspirin is being prescribed because it will protect your heart. c. The aspirin is being prescribed because it reduces your risk of a second heart attack. d. The aspirin is being prescribed to relieve the pain from the heart attack.

c. The aspirin is being prescribed because it reduces your risk of a second heart attack. Because of its antiplatelet and anti-inflammatory effects, low-dose aspirin (81 mg daily) is useful in preventing or reducing the risk of transient ischemic attacks (TIAs), MI, and ischemic cerebral vascular accident (stroke). It is also indicated for clients with a previous MI, chronic or unstable angina, and those undergoing angioplasty or other revascularization procedures.

The client has a history of gastrointestinal bleeding. What would be the best response by the nurse when the health care provider prescribes Indocin as treatment for rheumatoid arthritis? a. Add a PPI medication to the treatment plan. b. Administer the medication. c. Withhold the medication and notify the provider. d. Discontinue the medication.

c. Withhold the medication and notify the provider. The most appropriate action of the nurse is to hold the medication and notify the provider of the client's history of GI bleeding. An adverse reaction associated with Indocin is GI bleeding. The nurse cannot discontinue or add medications to the treatment plan without prescriptive authority.

A parent has brought a 6-year-old child to the clinic. The child has a fever of 102.8°F (39.3°C) and is subsequently diagnosed with the flu. What medication best balances risks and benefits for treating this client's fever? a. etanercept b. penicillamine c. acetaminophen d. aspirin

c. acetaminophen Acetaminophen would be the suggested medication. It is prescribed for relief of pain and fever for influenza in children. Aspirin would be contraindicated because it increases the risk for Reye syndrome. Etanercept and penicillamine are given for severe rheumatoid arthritis therapy.

A nurse will instruct a patient taking allopurinol to take each dose a. at night. b. first thing in the morning. c. after a meal. d. before a meal.

c. after a meal. The nurse should teach the patient to take each dose after a meal to decrease the potential for nausea and vomiting. Taking this medicine at night, in the morning, or before a meal would not help decrease the GI symptoms associated with this drug.

Antipyretic drugs, such as aspirin, ibuprofen, and acetaminophen, often are used to alleviate the discomforts of fever and protect vulnerable organs, such as the brain, from extreme elevations in body temperature. However, the use of aspirin in children is limited due to the possibility of what disease? a. Munchausen syndrome b. Guillain-Barre syndrome c. Angelman syndrome d. Reye syndrome

d. Reye syndrome Salicylates are contraindicated in the presence of known allergy to salicylates, other NSAIDs (more common with a history of nasal polyps, asthma, or chronic urticaria), or tartrazine (a dye that has a cross-sensitivity with aspirin) because of the risk of allergic reaction; bleeding abnormalities, because of the changes in platelet aggregation associated with these drugs; impaired renal function, because the drug is excreted in the urine; chickenpox or influenza, because of the risk of Reye's syndrome in children and teenagers; surgery or other invasive procedures scheduled within 1 week, because of the risk of increased bleeding; and pregnancy or lactation, because of the potential adverse effects on the neonate or mother. Munchausen syndrome is an unusual condition characterized by habitual pleas for treatment and hospitalization for a symptomatic but imaginary acute illness. Guillain-Barre syndrome is an idiopathic, peripheral polyneuritis that occurs 1 to 3 weeks after a mild episode of fever associated with a viral infection or with immunization. Angelman syndrome is an autosomal recessive syndrome characterized by jerky puppet-like movements, frequent laughter, intellectual disability, motor retardation, a peculiar open-mouthed facial expression, and seizures.

The nurse is checking the orders for pain management for a client that had coronary surgery 24 hours ago. The nurse identifies that the client has been receiving Celebrex and a narcotic postoperatively for pain management. What is the most appropriate response of the nurse? a. Administer the Celebrex and narcotic because it is his pain management regimen. b. Administer the Celebrex. c. Discontinue the Celebrex. d. Withhold the Celebrex and notify the health care provider.

d. Withhold the Celebrex and notify the health care provider. Celebrex should not be used for pain management after coronary surgery due to the risk of cardiovascular thrombosis, myocardial infarction, and stroke. The nurse should not administer the medication and should notify the provider. The nurse cannot discontinue the Celebrex without prescriptive authority.

While providing client teaching relative to inflammatory disorders, the nurse would explain the presence of inflammation as: a. the initial stage of infection, requiring antibiotic medication for resolution. b. a normal response to infection or trauma, which results in necrotic tissue formation. c. a typical response to bacterial infection. d. an attempt by the body to remove the damaging agent and repair the damaged tissue.

d. an attempt by the body to remove the damaging agent and repair the damaged tissue. Inflammation is the normal body response to tissue damage from any source, and it may occur in any tissue or organ. Local manifestations are redness, heat, edema, and pain. Inflammation may be a component of virtually any illness. Inflammation can be a result of an infection, which may require antibiotic therapy.